Community Health Needs Assessment
Survey Questions

Mental health is a key part of your overall health.  We know that one in five US adults live with mental illness each year and one in twenty US adults experience serious mental illness each year--National Alliance on Mental Illness 2023. At Highland-Clarksburg Hospital, we are here to help.

We will be asking for your opinion in order to better understand people's relationship with mental health issues. Your answers will be used as part of our effort to improve the mental health of the residents of West Virginia. Thank you for taking part in this important survey about the mental health issues in our area.

This survey should only take 5 to 7 minutes to complete. Your responses will not be associated with you in any way. 

 First, we’d like to have some individual demographic characteristics.

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* 1. What is your age group?

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* 2. What is your gender preference?

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* 3. What is your marital status?

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* 4. Please select your ethnicity:

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* 5. What is your employment status?

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* 6. Please select the range of your annual household income:

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* 7. What is the highest level of education you have completed?

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* 8. In what COUNTY is your home located?

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* 9. Do you have children under age 18 living in your household?

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* 10. Do you care for an elderly relative?

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* 11. In general, how healthy do you feel?  Using any number from 1 to 10, where 1 is the worst health and 10 is the best health.

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* 12. Have you or someone in your household used alcohol to excess in the past 12 months?

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* 13. Have you or someone in your household used tobacco products in the past 12 months?

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* 14. Have you or someone in your household used non-prescribed or recreational drugs in the past 12 months?

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* 15. If yes, does someone in your household need, but is not receiving, treatment for any of the following? Choose all that apply.

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* 16. From the following list, which do you think are the 3 most important issues related to personal choices or risky behaviors in your county?  Please choose only 3.

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* 17. What do you believe will be the greatest needs for mental health treatment in West Virginia? Choose all that apply.

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* 18. In general, how happy do you feel? Using any number from 1 to 10, where 1 is very unhappy and 10 is very happy.

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* 19. How have you or someone in your household been feeling lately? Choose all that apply.

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* 20. My family has easy access to the behavioral health specialists we need.

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* 21. My family is able to get behavioral health care whenever we need it.

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* 22. If you disagree, why? Check all that apply.

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* 23. If your family has used behavioral health services, how satisfied were you with the quality of care received?

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* 24. Do you think Highland-Clarksburg Hospital should help by offering educational classes or advocacy about any of the following? Choose all that apply.

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* 25. Do you have internet access to allow for video conferencing, like Tele-Medicine?

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* 26. Do you think Highland-Clarksburg Hospital should help by offering counseling about any of the following? Choose all that apply.

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* 27. Have you or someone in your household used the services of Highland-Clarksburg Hospital?

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* 28. If yes, which service(s) were used at Highland-Clarksburg Hospital?

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* 29. If yes, how satisfied were you or someone in your household with the services you received at Highland-Clarksburg Hospital?

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* 30. Finally, we would like to know if you have any comments that you think Highland-Clarksburg Hospital should be aware of.

Everyone experiences stress, sadness and anxiety from time to time—it’s part of life.
But if you are feeling overwhelmed, depressed, or unable to do the things you once enjoyed, or if you are concerned about someone you love, contact Highland-Clarksburg Hospital.  We want to help –304-969-3100 or 885-432-4042—Open 24/7 

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